Aix Marseille université, IRD, SSA, VITROME, IHU-Méditerranée Infection, AP-HM, 13005 Marseille, France.
Service de maladies infectieuses et tropicales, centre hospitalier de Villeneuve, 94190 Villeneuve-Saint-Georges, France.
Med Mal Infect. 2019 Mar;49(2):121-132. doi: 10.1016/j.medmal.2018.11.011. Epub 2018 Dec 6.
Lyme disease is a tick-borne bacterial disease with polymorphic clinical manifestations (cutaneous, rheumatological, and neurological). In recent years the issue of the diagnosis of this infection has been highly publicized on the Internet and other media in Europe and America. Some patients and physicians may share the perception that the diagnosis of the infection is not reliable in France. We reviewed current European and American guidelines on Lyme disease and performed a methodological evaluation of all guidelines. We retrieved 16 guidelines from seven countries. Our analysis revealed a global consensus regarding diagnosis at each stage of the infection. All guidelines indicate that the diagnosis is currently based on a two-tier serology at all stages of the infection, except for the early localized dermatological presentation known as Erythema migrans. One text of so-called guidelines has discordant recommendations when compared with the other guidelines, possibly explained by its low quality score. Contrary to the intense debate taking place on the Internet and in the European and American media, our analysis shows that the great majority of medical scientific guidelines with a high quality score, agree on the clinical diagnostic methods of Lyme disease.
莱姆病是一种由蜱传播的细菌性疾病，具有多种临床表现（皮肤、风湿和神经）。近年来，在欧美互联网和其他媒体上，该感染的诊断问题备受关注。一些患者和医生可能认为法国的这种感染诊断不可靠。我们回顾了当前欧洲和美国的莱姆病指南，并对所有指南进行了方法学评估。我们从七个国家检索到 16 项指南。我们的分析显示，在感染的各个阶段，全球对诊断均达成共识。除了早期局部皮肤表现（称为游走性红斑）外，所有指南都表明目前在感染的各个阶段都基于双阶段血清学检测进行诊断。在与其他指南进行比较时，一份所谓的指南中的建议存在不一致，这可能是由于其质量评分较低所致。与互联网和欧美媒体上激烈的辩论相反，我们的分析表明，大多数具有较高质量评分的医学科学指南都同意莱姆病的临床诊断方法。
